Evidence Summary

A pilot study published in 2018 examined the effect of aerobic exercise, resistance exercise and no exercise on sleep and rates of nocturnal hypoglycaemia in 10 adults (age 21-45 years) with type 1 diabetes [1]. The controlled experiment was carried out using a crossover design over a 3-week period. Aerobic and resistance exercise sessions consisted of two 45-minute sessions per week with glucose and sleep monitored at home after exercise sessions were completed. Following aerobic and resistance exercise sessions, participants lost 70+49 minutes of sleep (p=0.0015) and 27+78 minutes of sleep (p=0.3), respectively, in comparison to control nights after no exercise had been performed. The occurrence of nocturnal hypoglycaemia increased following aerobic exercise in comparison to the control group (Odds Ratio 5.4; Confidence Intervals 1.3, 27.2) and was similar following resistance exercise and no exercise (Odds Ratio 7.0; Confidence Intervals 1.7, 37.3). 

Quality of Evidence

C – this was a pilot study and therefore larger trials are necessary to determine the effect size accurately, uncertainty exists about the benefits and risks.

Strength of Recommendation

2 – this recommendation cannot be generalised to all patients with type 1 diabetes at this stage with the limited evidence that exists.

Conclusion

Aerobic exercise had a significant effect on sleep loss and nocturnal hypoglycaemia in people with type 1 diabetes. There a number of benefits of physical activity for people with type 1 diabetes, including reducing the risk of macro- and microvascular complications, therefore before this evidence can be strongly recommended further trials are necessary and consideration of additional recovery strategies, including carbohydrate and insulin dosing post-exercise, should be considered. On the basis of the existing evidence, some patients will be best served by following this piece of evidence. In the context of values-based decision making, fully informed patients may choose alternative options.

References

1. Reddy R, El Youssef J, Winters-Stone K, et al. The effect of exercise on sleep in adults with type 1 diabetes. Diabetes, Obesity and Metabolism 2018;20(2):443–447. DOI: 10.1111/dom.13065.